PURPOSE. To examine asymmetry in vertical optic disc parameters among subje
cts classified as normal, as having ocular hypertension (OH), and as having
open-angle glaucoma (OAG) in a population-based sample.
METHODS. The Blue Mountains Eye Study examined 3654 people aged 49 to 97 ye
ars, including 2929 normal subjects, 118 with OH, and 79 with OAG in the gr
oups of interest for the asymmetry study. Optic disc parameters were measur
ed in a masked manner from stereo optic disc photographs.
RESULTS. Vertical disc diameter asymmetry (the absolute value of left minus
right disc diameters) was similar among normal, OH, and OAG groups (median
, 0.07-0.08 mm). Vertical cup-disc ratio asymmetry was higher in patients w
ith OAG (median, 0.11) than in normal subjects (median, 0.06; P < 0.0001) a
nd in those with OH (median, 0.05; P < 0.0001) but was similar between norm
al subjects and patients with OH (P = 0.17). A cup-disc ratio asymmetry of
0.2 or more was found in 24% of patients with OAG, compared with 1% of pati
ents with OH and 6% of normal subjects. Corresponding rates for cup-disc ra
tio asymmetry of 0.3 or more in these three groups were 10%, 0%, and 1%, re
spectively. Using multiple linear regression, cup-disc ratio asymmetry was
associated with disc diameter asymmetry and intraocular pressure asymmetry.
However, these two factors explained only 3% of the variability of cup-dis
c ratio asymmetry and 20% of cup diameter asymmetry.
CONCLUSIONS. Despite differences between the OAG group and either the OH or
normal groups, asymmetry alone was not useful in identifying patients with
OAG. At all levels of asymmetry, subjects were more likely to be classifie
d as normal than with OH or OAG.